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MAP II Final > Obstructive vs. Restrictive lung disease > Flashcards

Obstructive vs. Restrictive lung disease Flashcards

1
Q

obstructive is characterized by?

A
  • airflow obstruction
  • increased airway resistance
  • often affects expiratory flow rate
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2
Q

restrictive lung disease is characterized by?

A
  • reduced lung compliance
  • reduced thoracic compliance
  • often affects inspiratory volume
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3
Q

obstructive lung disease (OLD) includes:

A
  • chronic bronchitis
  • emphysema
  • bronchiectasis
  • asthma (also restrictive)
  • CF
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4
Q

Restrictive lung disease

A
  • interstitial lung disease

- idiopathic pulmonary fibrosis (IPF)

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5
Q

OLD - epidemiology

A

3rd leading cause of death in US

  • smoking is primary risk factor
  • 11th year demonstrating more women die from diagnosis of COPD than men
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6
Q

OLD radiographs

A
  • flattened diaphragm
  • hyperinflated lungs due to air trapping
  • enlarged heart with enlarged right ventricle
  • barrel chest
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7
Q

OLD potential consequences

A
  • destruction of lung tissue resulting in emphysema
  • inflammation of airways
  • hypoxemia
  • dysrhythmias
  • sleep disorders
  • repeated infections
  • build up of secretions
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8
Q

OLD consequences continued

A

polycythemia

  • adaptation to chronically low 02 - be careful giving more 02 –> reduces hypoxic drive to breathe
  • sluggish blood flow
  • right side heart failure
  • resistance to air flow -> inc. work of breathing
  • normal or increased lung capacity
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9
Q

Chronic bronchitis:

Diagnosis and causes

A

Greater than 3 months of productive cough most days in at least 2 consecutive years

causes:
- irritation of bronchial tree (smoke, particles)
- genetics
- respiratory infections

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10
Q

symptoms of OLD

A
  • secretion production
  • reduced cilia action leading to build up of secretions and bacteria
  • repeated infection, pneumonia
  • hypoxemia
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11
Q

Emphysema- End stage COPD

Definition and actions

A

Abnormal, permanent increased size of air sacs distal to terminal bronchioles by destruction of alveolar walls

  • alveolar destruction
  • over inflation of lungs, cannot empty
  • emphysematous bull
  • chronic hypoxia and hypercapnia (excessive CO2) in blood
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12
Q

Restrictive lung disease (RLD) includes?

A

decreased expansion of lungs

  • decreased total lung capacity
  • hypoxemia
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13
Q

Examples of RLD

A
  • disease of pleura
  • disease of chest wall (kyphoscoliosis, obesity)
  • extrapulmonary mass restricting expansion of lungs
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14
Q

causes of RLD?

A
  • stiffening of lung tissue preventing expansion
  • structural limitations preventing lung inflation (kyphoscoliosis)
  • interstitial lung disease
  • pleural abnormalities “trapped lung”
  • mass
  • lupus
  • pmneumothorax
  • connective tissue disease: scleroderma
  • radiation therapy
  • idiopathic pulmonary fibrosis (IPF)
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15
Q

Idiopathic pulmonary fibrosis

A

onset: middle age (50-70)
- 4-5 yrs life expectancy
- increased respiratory rate (30-40)
- hypoxemia, cyanosis –> give 02
- treat inflammation before it turns into fibrosis (corticosteroids)

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16
Q

Medical treatments for lung diseases?

A
  • steroids: for inflammation
  • antibiotics: for infections
  • 02: to treat hypoxemia
  • inhalers: for bronchospasm
  • assisted ventilation: invasive or non
  • lung transplant
  • lung reduction surgery
17
Q

Pulmonary function tests

  1. obstructive
  2. restrictive
A
  1. low FEV1, normal vital capacity

2. FEV1 normal, low vital capacity

18
Q

Blood gases normal values

A
  • Pa02: 85-100mmHg
  • PaCO2 35-45 mmHg
  • pH 7.35-7.45
  • SaO2 95-100
19
Q

PT assessment for lung disease includes?

A
  • 02 needed at least and for activity
  • blood gases
  • auscultation
  • RR, breathing patterns
  • endurance
  • perceived exertion
  • time to return to baseline HR & RR
  • Sa02
  • gait safety
  • education needs
  • lifestyle changes
20
Q

Precautions?

A
  • pt may have chronic hypoxemia –> certain level of hypoxemia required to inspiration. Over oxygenating these patients may decrease inspiratory drive
  • target Sa02 is lower: 88-92
  • time to return to steady state may be prolonged
  • few or now symptoms at low Sa02
  • low Sa02 will overtax heart and results in cell death, actual death
21
Q

Alert???

A
  • ILD and 02 desaturation
  • Monitor with pulse oximeter from start if you have pt with ILD
  • be prepared to see 02 saturation drop with minimal activity
  • always have full 02 tank
22
Q

PT treatments

A
  • breathing control
  • pacing skills/work simplification
  • endurance training
  • strengthening
  • education - 02 management, fatigue scale
  • confidence building
23
Q

Goal setting examples

A
  • pt. will complete supine to sit with minimal resistance of 1 person with RPE88, with contact guar of 1 person in 4 weeks
  • pt will tolerate 20 consecutive min of activity at RPE 6-8 independently within 4 weeks

MAP II Final (9 decks)

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